Communication-Focused Therapy (CFT) for Narcissism


Communication-Focused Therapy (CFT) for Narcissism

Christian Jonathan Haverkampf, M.D.

Communication-Focused Therapy (CFT) is a psychotherapy developed by the author, which can be applied to a number of mental health conditions, including narcissism.

Keywords: narcissism, communication-focused therapy, CFT, communication, psychotherapy, treatment

Table of Contents

Introduction. 4

Communication on the Inside. 4

The Self 5

Communication between the Inside and Outside Worlds. 5

Communication as Therapy. 6

Narcissism.. 7

Psychoanalysis. Error! Bookmark not defined.

Personality Variables. 7

Attributes of Narcissism.. 7

Avoiding Being Seen. 9

The Superficial Mirror Image. 9

Never Enough. 9

Interpersonal Communication Need. 10

Communication-Focused Therapy (CFT) 10

Communication is Life. 11

Information. 11

Information and the Physical World. 12

Entropy. 13

Resonance. 13

Autoregulation. 14

Understanding Narcissism.. 15

The Rise of Narcissism.. 15

Conversational Narcissism.. 17

Dysfunctional Interpersonal Relationships. 17

Social Interactions. 18

Learning About Others. 18

Control 19

Faith in Communication. 19

Meaning. 20

Experiencing the World. 20

Perceiving Meaning. 21

Representations. 21

From Inner to Outer World. 22

Values, Needs and Aspirations. 22

Meaningful Messages as the Instrument of Change. 23

Reconnecting with Oneself 23

References. 25



Narcissism is related to how an individual communicates with oneself. At the core of the condition, which can significantly interfere with one’s life, is a loss of connection with oneself, one’s values, basic interests, needs, wants and aspirations, the parameters which make oneself feel as oneself. The result is that there is a large unknown which can lead to fears about oneself and lower self-confidence. As a result, the individual engages in thoughts, activities and behaviors that try to communicate a more appropriate image of the self. However, in the case of narcissism, the internal communication patterns, the communication with oneself, are not flexible enough to change in a way that is sustainable and increases the happiness and content of the individual in the long run.

Narcissism is different from a healthy sense of self. The latter is important so that individuals can pursue what is important to them or just to feel happy with themselves. Narcissism is actually a sign of disconnect from oneself, when the own interests, needs and aspirations are no longer felt fully and the compass in life has become unreadable. As a reaction, the individual uses external pointers as guideposts in life, such as advertisement messages or own theories about other people’s expectations. Since a divergence between the own needs and wishes and others’ expectations is likely, one will be out of sync with oneself and not as happy in the long run.

Communication on the Inside

For various reasons the sense of self can seem incomplete, fractured or deficient. Often traumatic interpersonal experiences, and frequently prolonged low-level ones, can make it difficult to conceive of a self that is an effective support in the background. Rather, it becomes an issue because the usual communication and interaction processes, which are under normal circumstances what brings out the sense of a self, are used in self-defense rather as mutually constructive processes.

The Self

As already discussed, the self is an awareness for the communication flows within oneself. As the narcissists is driven towards portraying what they believe to be great and helpful images towards the world, their increasing disconnectedness from their true selves and from others reduces the awareness of this sense of self even more in a vicious cycled. As described elsewhere by the author (Haverkampf, 2010a), an awareness for and working with communications patterns, the dynamics of the flow of information between to people.                                                                                                                                                                                                                                                                                   

External communication (with others) and internal communication (with oneself) are closely linked, and both become rigid and unyielding in narcissism. The consequence is that the individual cannot use communication to get the own needs, values and aspirations met through communicating with oneself or others. This constant deficit causes much of the suffering in narcissism.

Communication between the Inside and Outside Worlds

Specific patterns of interpersonal behaviors for individuals with differing levels and types of narcissistic vulnerability have been empirically investigated. (Kerr, Patton, Lapan, & Hills, 1994) Generalizing interpersonal behaviors as an aspect of transmitting messages between people, it is easy to see that communication patterns are considerably influenced, selected and modified by any present narcissism.

The outside world becomes more important to someone suffering from narcissism because, having a lower opinion about oneself, the individual tries to find part of the self and a connection with it in others. However, the weak sense of self on the inside makes holding apart the inside and outside worlds more difficult, not to the extent in psychosis or in Borderline disorder, but to keep them apart requires some activity, which is in an overcompensation in the outside world. Since the inside world remains partly unknown, the narcissist relies more on the outside than the inside world.

Since the individual suffering from narcissism spends more time in the outside world, it assumes disproportionate importance in the life of the individual. The consequence of the missing insight into the inside world makes communication between the inside and outside world difficult, which leads to a shift in some of the tasks of the inside world to the outside. For example, rather than judging oneself whether one has succeeded in a task, the power of judgment is now given to others, which makes one even more dependent on the opinions of others. It is as if the own internal capabilities have been switched off to a lesser or greater extent.

Communication as Therapy

Communication is an important tool to resolve the internal deficit by helping the individual to have a better contact with himself or herself again. Through communication we experience and see the world. When little children explore the world, they are already in search of meaningful information, information that brings about a change in an internal state. The quest for meaningful information is programmed into every organism as a means for survival. Being connected leads to more meaningful information, which also explains the need for attachment or relationship formation in general. Communication-Focused Therapy focuses on the general and unique communication patterns that determine how successful an individual is in acquiring meaningful information and using it to the own benefit (Haverkampf, 2010a, 2017a, 2018c).

Through the therapeutic process the individual can complete some of the work to build a stable sense of self by using communication to inquire in a safe environment into the own needs, wants, values and aspirations. This happens partly by reflecting on past life experiences and partly by connecting better with present experiences and states. The objective should be a more meaningful flow of information on the inside, as well as between the inside and the outside world. New communication


Narcissism is the pursuit of gratification from vanity or egotistic admiration of one’s own attributes. The term originated from Greek mythology, where the young Narcissus fell in love with his own image reflected in a pool of water. Sigmund Freud’s essay On Narcissism (1914) introduced narcissism into psychoanalytic thinking. The American Psychiatric Association has listed the classification narcissistic personality disorder in its Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1968.

Personality Variables

Four dimensions of narcissism as a personality variable have been delineated: leadership/authority, superiority/arrogance, self-absorption/self-admiration, and exploitativeness/entitlement.

The need for a reflection of oneself does not need to be pathological. In the “self seeking like” hypothesis of evolutionary biology, individuals unconsciously look for a “mirror image” of themselves in others, seeking criteria of beauty or reproductive fitness in the context of self-reference. Alvarez et al. found that facial resemblance between couples was a strong driving force among the mechanisms of assortative mating: human couples resemble each other significantly more than would be expected from random pair formation. Since facial characteristics are known to be inherited, the “self seeking like” mechanism may enhance reproduction between genetically similar mates, favoring the stabilization of genes supporting social behavior, with no kin relationship among them. Since the biology determines how information is exchanged and processed, this may favor certain communication patterns over others in a very slow adaptive process.

Attributes of Narcissism

Narcissists do not seem to feel bound emotionally by the needs and wishes of others. They prefer guilt over shame, as guilt allows them to dissociate their actions from themselves. However, since the narcissist still can communicate and understand emotional information, that is empathy, what it seems like on the outside may not be true on a lower psychodynamic level.

Narcissists appear to see themselves as perfect, using distortion and illusion known as magical thinking. They also use projection to place any negative feelings about themselves on others. However, the projection is necessary because at the core the narcissist cannot build a stable self-image from exchanging information with self and others. As already mentioned, the internal and external communication patterns are maladaptive (Haverkampf, 2010a) One result of maladaptive communication patterns is that narcissists need to patch and reinforce their sense of self-importance by diminishing, debasing, or degrading somebody else and minimizing their achievements. They can be very good communicators in one area, but a positive long-term effect for themselves is not sustainable.

Narcissists hold unreasonable expectations of particularly favorable treatment and automatic compliance because they need to consider themselves special. Failure to comply is considered an attack on them personally and they will describe the person in negative terms. Defiance of their will is a narcissistic injury that can trigger narcissistic rage. On a lower level, they need to consider themselves special, because there is a need to feel special in the world as an experience of one’s own inner world and the communication with the outside world does not bring enough satisfaction, contentment and happiness. Narcissism and a sustainable feeling of happiness basically exclude each other, because the communication patterns that play important roles in their etiology are at least to some degree mutually exclusive.

Narcissists seem to be able to exploit others with no regard for their feelings or interests. Often the other person is in a subservient position where resistance would be difficult or even impossible. Sometimes the subservience is not so much real as assumed. This exploitation may result in many brief, short-lived relationships. However, the difference between sociopathy and narcissism is that the latter actually has the instruments of empathy available, at least in theory, but is too afraid to use them. This dilemma is one more reason why narcissism is not associated with sustainable satisfaction and happiness.

Narcissists are often prevented from realizing that they have boundaries and that others are separate and are not extensions of themselves. Others either exist to meet their needs or may as well not exist at all. Those who provide narcissistic supply to the narcissist are treated as if they are part of the narcissist and are expected to live up to those expectations. In the mind of a narcissist, there is no boundary between self and other.

Avoiding Being Seen

Narcissism is not the same as egocentrism. Rather than wanting to be at the center of the world, narcissists are afraid that they could be seen for who they really are. A narcissist’s self-image is either diffuse or deficient, at least much of the time. Often, this is compensated for by portraying images of greatness and success, which masks the fear of connecting with oneself and conceals one’s sense of self to others.

The Superficial Mirror Image

The image the narcissist sees is never one that is deep enough to touch on properties of the core self, such as own values or aspirations. The world, and especially oneself, is thus of a lesser perceived value even though the narcissist tries to never let this fact enter consciousness. When it does, the individual experiences a narcissistic crisis, which is less an existential but more a value crisis.

Never Enough

Since the communication patterns with oneself and others stay underdeveloped, the perception of oneself and the world is narrowed. Less relevant and meaningful information can be received about oneself and the world, which makes it more difficult to see the positive and appreciate accomplishments and successes. This leads to a constant deficit in terms of perceiving meaning in oneself and others which can never be filled because the individual suffering from narcissism cannot conjure meaning out of thin air. Perception of meaning is a product of communication, which in the case of narcissism does not operate as efficiently as it could.

It has been argued that many people in the West live in a “culture of narcissism” in which the tendency is for individuals to focus on themselves to the detriment of others. (Leit, 2015) Whereas only an estimated 0.5–1.0% of the general population is diagnosed with Narcissistic Personality Disorder, narcissistic verbal and behavioral communication styles characterize over 75% of social interactions, frequently render others invisible, and predict negative mental and physical health outcomes, as well as relationship problems over time, while individuals with an inflated view of themselves, not necessarily to pathological levels, display self‐centered communication styles during interactions. These practices are often extremely subtle, as social norms prohibit overtly self‐centered behavior.

Interpersonal Communication Need

Narcissism entails the need for a message, which needs to be heard again and again, but is ‘never enough’ because the message that really needs to be heard cannot be received. The problem is thus looking in the wrong places for the wrong messages, which goes hand in hand with the use of maladaptive communication patterns. Communication-Focused Therapy focuses on awareness for and change in these communication patterns (Haverkampf, 2017a). Since information and communication dynamics are at the core of narcissism, and many other mental health conditions, working directly with them would be the logical approach for efficient psychotherapy.

Narcissistic supply is a concept introduced into psychoanalytic theory by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support or sustenance drawn by an individual from his or her environment and essential to their self-esteem. The term is typically used in a negative sense, describing a pathological or excessive need for attention or admiration in codependents and the orally fixated, that does not take into account the feelings, opinions or preferences of other people.

Communication-Focused Therapy (CFT)

Communication-Focused Therapy (CFT) was developed by the author to focus more specifically on the communication process between patient and therapist. The central piece is that the sending and receiving of meaningful messages is at the heart of any change process. Messages do not have to be contained in words and much of human communication is nonverbal. A meaningful message is one that has the potential to bring about a change, even if only small, in the recipient. It is a change that alters how information is processed in the future. For example, if someone tells me something that resonates with me and that I regard as relevant, it can change how I see or speak about something else in the future. These change and adaptation processes happen all the time as one grows in one’s sense of self and as a person. However, for various reasons, the process can be impaired or maladaptive. Given the ability of humans to think about their own thoughts (metacognition), one can increase one’s awareness of the communication with oneself and one’s environment, reflect on it and adjust these communication patterns.

Communication is Life

We engage constantly in communication. The cells in our bodies do so with each other using electrical current, molecules, vibrations or even electromagnetic waves. People communicate with each other also through a multitude of channels, which may on several technologies and intermediaries. It does not have to be an email. Spoken communication requires multiple signal translations from electrical and chemical transmission in the nervous system to mechanical transmission as the muscles and the air stream determine the motions of the vocal chords and then as sound waves travelling through the air, followed by various translations on the receiving end. At each end, in the sender and in the receiver, there is also a processing of information which relies on the highly complex networks of the nervous system. Communication, in short, happens everywhere all the time. It is an integral part of life. Certain communication patterns can, however, also contribute to experiencing anxiety, depression, paranoia or various other mental health conditions.


Information theory in science is concerned with quantifying information for communication (Haverkampf, 2018a). On the technical level this may include data compression and the capacity levels of a channel. However, in an everyday communication setting, such as in psychotherapy, these concepts all play a role. A patient’s (or a therapist’s) communication patterns may, for example, select some information to be compressed so highly that the other person with their available decoding information will be left with so much uncertainty that they use their own imagination to make up most of the message. Information and communication theory are also important to understand the nature of information, and how meaningful information can lead to further changes and further communication.

Information theory began with Claude Shannon’s seminal paper “A Mathematical Theory of Communication” (Shannon, 1948) he wrote while working at the US telephone company Bell Labs. Information theory is concerned with representing data in a compact fashion (a task known as data compression or source coding), as well as with transmitting and storing it in a way that is robust to errors (a task known as error correction or channel coding). Since the transmission of information is at the starting point of any change process, including psychotherapy, understanding how information is created and transmitted forms the foundation of understanding psychotherapeutic change processes.

Information and the Physical World

Classical Information Theory is the mathematical theory of information–processing tasks such as storage and transmission of information. Quantum Information Theory, on the other hand, brings together ideas from Classical Information Theory, Quantum Mechanics and Computer Science. In quantum information processing systems, information is stored in the quantum states of a physical system. In the real world there are no perfectly isolated systems, however, which is often used as a basic assumption in quantum mechanics.

The ubiquity of communication makes information processing systems in the world, such as the human brain and all its components down to the level where quantum considerations play a role, practically open systems. If the communication or interference is unintended or unwanted, we would call this noise. However, noise in a physical sense does not contain information, and it should also be defined in the same way in a psychotherapy session. A Freudian slip is thus not noise, but a communication that contains meaningful information.


If one gets the message one expects as certain, the information does not carry any value or meaning. However, when a person or event produces an unlikely piece of information, it carries more “information” than when the piece of information would have been more likely. The level of the potential surprise is the entropy. Entropy is zero when one outcome is certain to occur. Information entropy is the average rate at which information is produced by a random source of data. Entropy takes into account the probability of observing a specific event, but not the meaning of the events themselves. However, since meaningfulness is the propensity for change a piece of information can cause in a recipient, a greater novelty and unexpectedness in a message, which is more likely to trigger a change, can also contain more meaning. Thus, entropy and the potential meaning encapsulated in a message are related. Of course, whether the meaning will lead to a change in the other person depends on their ability to decode the information and on the resonance with other information in the receiver of the message.


Resonance is the extent to which information can trigger change in a recipient. This plays an important role in psychotherapy, because a patient may be able to decode a message, but it does not produce an effect, or a different effect, because the sender of the message misjudged the information the recipient has available. Resonance is thus related to the information the other person already had, as well as how effective the communication patterns are on both sides. If the communication patterns change and more information can be absorbed, the resonance for a wider variety of new meaningful messages can increase.

One of the reasons for the problems someone with narcissism experiences is a reduced resonance for important self attributes in communication with oneself and others. If one has not learned an effective way of finding information about oneself or has not been given the information that can lead to resonance in respect to that information, there will be less resonance, and as a consequence less sensitivity for meaningful information that could bring about change with respect to the sense of self.


Communication is an autoregulatory mechanism. It ensures that living organisms, including people, can adapt to their environment and live a life according to their interests, desires, values, and aspirations. This does not only require communicating with a salesperson, writing an exam paper or watching a movie, but also finding out more about oneself, psychologically and physically. Whether measuring one’s strength at the gym or engaging in self-talk, this self-exploration requires flows of relevant and meaningful information. Communication allows us to have a sense of self and a grasp of who we are and what we need and want in the world, but it is to a significant degree learned.

In the case of narcissism, autoregulation no longer works effectively because the communication patterns the autoregulation is built on cannot work effectively. Rather than returning to a steady state of satisfaction, contentment and relative happiness, the communication patterns lead to a continued unsatisfied craving for the reflection of an idealized image of the self, which can never be reached. One reason is, of course, the instability of the idealization.

Autoregulation is a process within many biological systems, resulting from an internal adaptive mechanism that works to adjust (or mitigate) that system’s response to stimuli.  This is so-called “steady-state system”. Autoregulatory processes do not necessarily require a static state to which the system will always return. However, a basic reference point in which the quality of life is not interfered with too much gives us a broad framework for any more detailed references points. Since a person who exhibits narcissistic communication patterns with themselves and the world is usually impaired in realizing their true values, their quality of life is reduced. As the communication patterns and systems are not as effective, the feedback loops which could bring about a return to behaviors and interactions that readjust the state of life into a direction that is better aligned with the own basic parameters, the needs, values and aspiration, are not working as well.

Communication patterns are autoregulatory because they can regulate their own configuration, and this autoregulation is a central element of how communication patterns work. However, other than most biological processes, the target state can change over time. If the target states are too static and rigid, the whole system becomes more fragile. Narcissism, and most other personality disorders, leave the patient generally in a more fragile state.

Understanding Narcissism

Narcissism is linked to one’s communication patterns, because it tries to conceal and project images of oneself at the same time. Since this is difficult to accomplish in the long-run, problems and symptoms ensue.  Often, relationships become fragile and the performance in the workplace, though frequently high, suffers because it becomes difficult to maintain thoughts and actions which do not feel authentic and true to oneself. The gap between the perception of oneself and that by others can also cause major problems. In one study,” narcissism was related to enhanced leadership self-perceptions; indeed, whereas narcissism was significantly positively correlated with self-ratings of leadership, it was significantly negatively related to other ratings of leadership.” (Judge, LePine, & Rich, 2006) The study also revealed that narcissism was related to more favorable self-ratings of workplace deviance and contextual performance compared to other (supervisor) ratings. In another study of 197 employees, anger mediated the relationship between lack of reciprocity and incivility, and this indirect effect was stronger among narcissists. (Meier & Semmer, 2013)

The Rise of Narcissism

As has been outlined above and discussed by the author elsewhere (Haverkampf, 2010b), a well working internal and external connectedness is a powerful antidote against narcissism. If this connectedness cannot be fully developed or is impaired due to fears or missing role models, particularly in childhood and adolescence, the risk of narcissistic personality traits and maladaptive communication patterns increases. A society can foster effective, positive and helpful communication or lead to greater disconnectedness, isolation and non-interactive and meaningless communication. If this is combined with narrowly defined yardsticks for success and a well-live life, the result can be catastrophic for a healthy sense of self, leading to an underdevelopment, which gives rise to narcissistic communication patterns with others and with oneself.

Dimaggio and colleagues have described several factors that seem to contribute to a narcissistic personality (Dimaggio et al., 2002):

  • a characteristic set of states of mind
  • alterations in metacognitive skills, in particular a difficulty in accessing one’s own inner states, desires, and emotions, and a difficulty in understanding another’s mind from a decentrated perspective
  • the sensation that experiences are not being shared with a relevant other and that one does not belong to real-life groups
  • characteristic methods of regulating one’s self-image and self-esteem through cognitive biases
  • the use, in most cases, of values, rather than emotional experience and interpersonal regulation, for regulating behavior, and
  • characteristic dysfunctional interpersonal cycles.

From a more classical psychoanalytical perspective, the narcissistic subject does not recognize the other as the object of an unconscious dialogue, leading to the collaboration of a subject and an object who have established a tie with the aim of maintaining the illusion that this subject can dispense with all objects. (Maldonado  Luis, 1987) The cognitive–behavioral therapy (CBT) literature on narcissism is comparatively sparse (Kealy, Goodman, Rasmussen, Weideman, & Ogrodniczuk, 2017). From a CFT perspective, narcissism is a partial malfunctioning of communication patterns (Haverkampf, 2018b).

Significant energy is expanded by individuals suffering from narcissistic personality traits to draw attention to themselves, partly because they do not know and understand themselves as fully as would give them a greater sense of security, contentment and satisfaction with themselves and others. Functional patterns through which narcissistic individuals attempt to confirm their grandiosity in the external world and  stereotyped cycles (zest alternating with disappointment) reflect narcissistic persons’ futile efforts to feed their grandiose expectations (Švrakić, 1990). The need to communicate and invite a reflection of an idealized, but largely unknown image of themselves, can show in any form of communication, and if it is less feasible in one communication mode, it can become more pronounced in others. In one study, people who used relatively few first-person singular pronouns (e.g., “I,” and “me”), displayed more self-promoting and sexy images of themselves on their profile pages and would use more profane and aggressive words in an online self-descriptive task (Nathan DeWall, Buffardi, Bonser, & Keith Campbell, 2011).

Conversational Narcissism

Conversational narcissism is a style of communicating which exhibits the hallmark features of a narcissistic personality. It is typified by an extreme self‐focusing in a conversation, to the exclusion of appropriate concerns for the other. It may be described as boasting, refocusing the topic of the conversation on the self, exaggerating hand and body movements, using a loud tone of voice, and “glazing over” when others speak  (Vangelisti, Knapp, & Daly, 1990). Conversational narcissism is generally perceived as a negative social strategy, respondents reported a number of contexts in which focusing attention on the self (to the exclusion of the other) is an appropriate move. (Vangelisti et al., 1990) One important step in therapy is to make a patient aware of these dynamics. Many people assume that narcissistic individuals are fully aware of their communication styles and patterns, which is, however, often untrue. For example, the communication pattern of pulling the focus back to oneself, may be less obvious to a patient, who often benefits significantly from looking at this dynamic from an observer’s distance (Haverkampf, 2010a, 2017b, 2019) Covert narcissism has been defined as hypersensitivity to criticism and overcompensating with inflated self-exaggeration, and associations between frequency, self-dominance, ruminating about conflict and narcissism as well as significant associations between lack of compensation, relational maintenance, and covert narcissism have been found. (Honeycutt, Pence, & Gearhart, 2013)

Dysfunctional Interpersonal Relationships

As already mentioned above and described by the author elsewhere (Haverkampf, 2019), the communication patterns used by someone with narcissistic personality attributes are less effective in transporting meaningful information and more prone to errors in all areas, whether on the sender’s or receiver’s side in an interaction. Narcissism is thus unsurprisingly associated with dysfunction in interpersonal relationships. In one study employing dyadic data analysis, women with higher levels of narcissism demonstrated significantly higher levels of hostility, as did their male partners. Men also displayed more anger if their female partner had higher levels of narcissism. Narcissism was not associated with observed positive affect in any of the analyses. (Lamkin, Lavner, & Shaffer, 2017)

Social Interactions

Communication in various media in mass publications has been investigated. In one study, problematic selfhood was found. The study’s data also suggested a fractured public culture, where public actions reflect the inner workings of personality rather than impersonal codes of meaning. (Goldman, 1991) In a study of 212 active Instagram users in Korea, the results showed that individuals higher in narcissism tended to post selfies and self-presented photos, update their profile picture more often, and spend more time on Instagram, as compared to their counterparts. They also rated their Instagram profile pictures as more physically attractive. (Moon, Lee, Lee, Choi, & Sung, 2016) In a Chinese study on Weibo microblogs, results showed that narcissism, content‐, and social‐gratification were positively related to intensity of Weibo use (Mo & Leung, 2015) In another Chinese study on microblogging, regression results indicated that narcissism and social anxiety are positively related to the intensity of microblog use and, although narcissism has a positive effect on both types of social capital (bridging and bonding), the effect was partly mediated by the intensity of microblog use. (Mo et al., 2014)  In other words, narcissistic individuals may even communicate more than others, but their greater amount of communication is probably also needed because their communication patterns and styles in the end do not satisfy what is missing, a greater meaningful connectedness with oneself and the world, the secret wish of every narcissistic inclination.

Learning About Others

The narcissistic patient uses communication to collect information primarily about others’ perception and expectations about himself or herself rather than truly learning about the other. The communication patterns are cautious about feedback out of fear of suffering a narcissistic injury, but at the same time try to elicit information which can lead to narcissistic injury, the other’s superficial assessment of oneself with a deeper understanding of the other person, which is aligned with fears in a narcissistic mode of thinking.

In group psychotherapy, for example, feedback between participants structures the relational process. However, fears of narcissistic injury engender resistance to this form of engagement. In one model, feedback is intended to inform recipients about themselves and to change their behavior accordingly, which is consistent with narcissistic beliefs in the power of others’ perceptions to control one’s being identity, or value. The more productive model, however, is to use feedback to gain insight into the inner worlds of others. (Cohen, 2000) Communication patterns in narcissism thus use feedback very narrowly, which also impedes real development and change in the sense of the autoregulatory processes which have been discussed above. Using communication in a psychotherapeutic session to illustrate that these maladaptive communication patterns actually mean less power for the patient in influencing and shaping social interactions and thereby realizing own needs, values and aspirations.


Communication is usually used to have some influence over the internal and external worlds, whether autoregulatory or not. As the communication patterns in the case of narcissism, and in many other mental health conditions, are less effective, the patient notices at the same time that there is less influence but also a greater need for control because of the greater disconnect, and the instability that comes from it. A study involving 239 college students revealed that the main reasons for the use of the social platform Instagram are “Surveillance/Knowledge about others,” “Documentation,” “Coolness,” and “Creativity.” In reference to narcissism, there was a positive relationship between using Instagram to be cool and for surveillance. (Sheldon & Bryant, 2016) Narcissism is thus associated with both, a need for greater control of self and for greater control of others. However, these impossible and thus unmet needs lead to even greater insecurity and an even greater need for control, as the world seems less stable, predictable and safe for the fearful self.

To solve the issues mentioned, it is important to raise the patient’s awareness for and need of a more complete and effective communication with oneself and others. Openness and transparency represent part of the solution, although they are often resisted. It requires the individual suffering from narcissism to face the fears of connecting with oneself and being more open with others, so that a greater exchange of meaningful messages is possible.

Faith in Communication

The faith in one’s own ability of an effective communication with others, through which own wants and needs can be met often needs to be rebuilt in someone suffering from narcissism. This requires reflecting on communication in therapy and developing skills that give the individual a sense of competency in effecting oneself and the world, which in turn builds greater confidence.

Faith is built on a feeling, and the emotions usually require significant amounts of information as input. It is thus very difficult, if not impossible, to think oneself into a state of faith. The information needed to reach this state can only come through communication with oneself and others, and the openness and receptivity to listen to it. Someone suffering from narcissism often cannot shape the communication patterns to an extent that would be necessary to build enough faith in one’s communication competence.


Meaning only exists partially in the world to the narcissist because of the disconnect from oneself. Reconnecting with values, interests and aspirations is an important step to increase meaning. At the same time, emotional difficulties from the past may need to be resolved to make an emotional reconnection possible.

An important step in therapy thus to make the person aware of how the fear of connecting with oneself affects one’s thinking. Individuals from anxiety often focus differently from other individuals. There is often a focus on worst outcomes and strong fears which are caused by it. Underlying this are often strong emotions or conflicts which need to be defended against. The danger and uncertainty is quite frequently inside oneself, rather than on the outside. An individual with a fear of flying may be more afraid of not containing oneself and not being able to leave the plain than anything else. Anxiety is the fear of crashing oneself and the feelings of a dreaded uncertainty about oneself and one’s emotional states.

Experiencing the World

To break through the vicious cycle of anxiety, in which emotions like fear and anxiety cause safety thoughts and behaviors, which in turn reinforce feelings of fear, loneliness, sadness, and so forth, it is helpful to focus on identifying what is meaningful and having more of it in life. Communication helps in identifying and finding meaning, either communication with oneself or with others. The exchange of messages is like a learning process in which meaning can be identified, found and accumulated. Through meaningful interactions one accumulates more meaning, more connectedness with oneself and the world and reduces the need for thoughts and behaviors which are triggered by fears, guilt, self-blame and other negative emotions. This also helps against depression and anxiety.

Perceiving Meaning

Perceiving meaning inside oneself and in the world, goes hand in hand. It is when one is open to information which has the potential to bring about a change in oneself. Meaning is both uniquely personal and a universal process, which motivates one to communicate and provides the means to change oneself and the world around. To someone suffering from narcissism, there is less which seems inherently meaningful because to identify and understand meaning requires that one can connect with something without knowing whether one will be successful. If something feels meaningful it is primarily because someone can generate the feeling on the inside, which, however, requires that one experiences a representation of the activity, object or person as meaningful on the inside.


Representations are merely memories of communication events. To have a representation of something requires either that a thought, feeling or sensory input is linked to another thought, feeling or sensory input. Meaningful information means there is a disruption, though it can bee very small, and at least a new connection or a new state. Meaning thus requires some resonance on the inside, because the message has to be able to elicit a change. To a narcissist who has less access to the inner world, there is less resonance, and thus less which can potentially be meaningful. The inner world and the representations are there, but they need to be given greater access through reconnecting.

From Inner to Outer World

Perceiving more meaning also makes interacting with others and oneself more meaningful. This has a positive effect on one’s interaction patterns, how and in which ways one relates to one’s environment and exchanges messages with it. A narcissist often approaches this from the wrong way. Rather than focusing on accessing the inner world, the narcissist tries to gain access to the inner world through the outer world. By portraying greatness or trying to achieve something for the sake of achieving it, he or she hopes to elicit some feeling on the inside, some resonance on the inside with the outside world, which confirms inner greatness. This is reminiscent of Narcissus in Greek myth who looked into a pool (in the outside world) to fall in love with his image (a superficial image of the inner world).

In therapy, it is important to help a patient to get to know and interpret the inner world in a helpful way. This requires being able to identify own thoughts and feelings and reflecting on them to an extent that one gets beyond the surface. The patient can then practice this in everyday life. The result should be better suited communication patterns with oneself, and, consequently, with others.

Values, Needs and Aspirations

Often, individuals suffering from narcissism are uncertain about what is truly important to them and the fit between these values and interests and their current life situation. Whether in the professional or romantic realms, getting what one needs and values makes happy, content and satisfied in the long run. Due to the disconnect a narcissist has with the own inner world, there is a lack of knowledge about the own values, needs and aspirations, which explains a number of the symptoms that are associated with narcissistic personality disorder.

In narcissism, an individual has impaired contact with himself or herself, which also means that the values, needs and aspirations are not as clear. The consequence is that the reading from the own compass is unclear and a sense of direction is missing. However, since there is still the need for life and self-actualization, the individual ends up in a difficult place, where no matter how hard he or she tries, there is never the sense of happiness and content people can experience who do not suffer from narcissism. It is easier for them not to get attached to a specific goal, unlike the narcissist who needs others to confirm an accomplishment to still the hunger for connectedness, even if only for a short while.

Meaningful Messages as the Instrument of Change

Communication is the vehicle of change. The instruments are meaningful messages which are generated and received by the people who take part in these interactions. In a therapeutic setting, keeping the mutual flow of information relevant and meaningful brings change in both people who take part in this process. The learning curve for the patient may be steeper in certain respects because he or she spends less time in this interaction style than a therapist.

Reconnecting with Oneself

Being open to oneself can be anxiety provoking for an individual suffering from narcissism. The disconnect form oneself has led to a great uncertainty about oneself, and, as a result, a sense of inner emptiness or void. It is important to work out with a patient suffering from narcissism that the sense of discontent and dissatisfaction with the self, which lies at the heart of the need for apparent greatness, that there is nothing wrong with the sense of self, but that the feelings are a result of not knowing enough about oneself.

Dr Christian Jonathan Haverkampf, M.D. (Vienna) MLA (Harvard) LL.M. (ULaw) trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland.

The author can be reached by email at jo****************@gm***.com or on the websites and


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